Intensive care units (ICUs) in rural hospitals offer essential services to their patients. The care provided by these units and the outcomes of that care are poorly understood. The specific objectives of this project are designed to provide needed information in this area and have the potential to improve the quality of care in rural ICUs. We will: 1) conduct a systematic evaluation of the care provided to ventilator-dependent patients in rural Iowa hospitals; 2) evaluate the statistical relationship between processes of ICU care and a range of health care and resource utilization outcomes; 3) implement and evaluate an outreach educational program; and 4) disseminate study findings and recommendations to rural hospitals. This research will employ a randomized design of 20 hospitals to two conditions: intervention and delayed-intervention. The study will test the effects of an innovative educational outreach program for ICU staff to improve processes of ICU care and subsequent patient outcomes for mechanically-ventilated patients. The intervention is designed primarily to improve ventilator management and weaning, the use of the laboratory, and the recognition of the need for transfer from the ICU. Outcomes to be followed include length of stay in the ICU and hospital, days on the ventilator, dollar costs, transfer rates of high-risk patients, nosocomial events, and discharge status. The program is tailored after an outreach model of neonatal care in Iowa since 1973. The proposed application to medical intensive care has been successfully pilot-tested.